Pain physician
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Patients with chronic whiplash associated disorders (WAD) demonstrate altered central pain processing and impaired endogenous analgesia. In addition, previous research reported disturbances in the autonomic nervous system and the presence of post-traumatic stress reaction in patients with chronic WAD. The autonomic nervous system, in particular the autonomic stress response, might modulate central pain processing in this population. ⋯ Results of this study refute autonomic dysfunction in response to pain in patients with chronic WAD. The autonomic nervous system activity or reactivity to acute pain appears unrelated to either pain thresholds or endogenous analgesia in patients with chronic WAD.
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Randomized Controlled Trial Multicenter Study
Tapentadol immediate release versus oxycodone immediate release for treatment of acute low back pain.
Tapentadol has demonstrated analgesic efficacy across a range of pain conditions. ⋯ NCT00986180.
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Multicenter Study
Pre-emptive and multi-modal perioperative pain management may improve quality of life in patients undergoing spinal surgery.
Compared to an abundance of data on surgical techniques for degenerative spine conditions and the outcomes thereof, little is available to guide optimal perioperative pain management after spinal surgery. The aim of this study was to survey patterns of perioperative pain management after spinal surgery and to investigate the effects of perioperative pain management, such as pre-emptive analgesia and multi-modal postoperative pain management, on acute postoperative satisfaction, pain reduction, and health-related quality of life in patients undergoing spinal surgery. ⋯ Pre-emptive analgesia and multi-modal pain management after spinal surgery may lead to better health-related quality of life, greater patient satisfaction, and less postoperative pain.
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Case Reports
Using pulsed radiofrequency ablation to treat pain associated with a tumor involving the brachial plexus.
Pain associated with cancer is often difficult to treat, even more so when tumors involve peripheral nerves. Therapy is complex and often requires a multimodal approach that can include medications, radiation, and interventional techniques. These components are utilized with variable success, but are also limited by known complications or adverse effects. ⋯ Pulsed radiofrequency is a poorly understood technology that has increasing evidence for certain pain conditions; however, for cancer and peripheral nerves the evidence is slim to none. Our case presents a successful use for pain management of a brachial plexopathy due to a tumor. We propose that pulsed radiofrequency may present a non-neurodestructive pain management technique for tumors involving peripheral nerves, though more data is definitely needed.
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Meralgia paresthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) characterized by pain, numbness or paresthesia on the anterolateral aspect of the thigh. Though several contributing factors have been identified, the cause of its idiopathic form still remains unclear. Anatomic and clinical studies have demonstrated a variable course for the LFCN and have suggested a contribution to the pathogenesis of MP. ⋯ The results of this study demonstrate a significantly different course of the LFCN, closer to the ASIS in patients with idiopathic MP.